Use of antidepressants by pregnant women: Evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making
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Background: The World Health Organization predicts that by 2012, depression will be the number one disease in the world. Thus, many women who become pregnant will require treatment with antidepressants. We are aware that women and their health care providers remain hesitant to prescribe and take these drugs during pregnancy, despite evidence of the relative safety.
Objectives: 1) To determine perception of risk of antidepressant drugs by pregnant women with depression, 2) to determine the efficacy of evidence-based counseling, and 3) to identify determinants that influence women in their decision making regarding the continuation/discontinuation of antidepressants during pregnancy.
Methods: Women who called The Motherisk Program requesting information about the safety of an antidepressant during pregnancy were compared with two other groups: 1) Women who called about antibiotic use (i.e., non-teratogenic drugs used short-term) and 2) women who called about gastric medications (i.e., non-teratogenic drugs used long-term). Their perception of risk was measured before and after evidenced-based information was given and determinants of decision making was also evaluated.
Results: We recruited 100 women taking antidepressants during pregnancy and 100 in each comparison group. Despite receiving evidence-based reassuring information, 15% of antidepressant users, compared to 4% using gastric drugs and 1% using antibiotics, chose to discontinue their medication. The main determinants of decision making were based on: information received prior to calling Motherisk, family and friends advice, the internet, sequence of advice given and if a women was undecided at the time of call.
Conclusions: Women continue to fear taking antidepressants during pregnancy, more so than non psychiatric drugs, however, evidence based counseling can lower this fear, although not totally. Deciding whether to continue to take a medication or not during pregnancy, is a complex decision for women and their healthcare providers to make.
- Bosquet, M, Egeland, B (2001) Associations among maternal depressive symptomatology, state of mind and parent and child behaviors: implications for attachment-based interventions.. Attach Hum Dev 3: pp. 173-199
- Chambers, CD, Johnson, KA, Dick, LM, Felix, RJ, Jones, KL (1996) Birth outcomes in pregnant women taking fluoxetine.. N Engl J Med 335: pp. 1010-1015 CrossRef
- Chung, TK, Lau, TK, Yip, AS, Chiu, HF, Lee, DT (2001) Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes.. Psychosom Med 63: pp. 830-834
- Einarson, A, Fatoye, B, Sarkar, M, Lavigne, L, Brochu, J, Chambers, C, Mastroiacovo, P, Addis, A, Matsui, D, Schuler, L, Einarson, T, Koren, G (2001a) Pregnancy outcome following gestational exposure to venlafaxine: a multicenter prospective controlled study.. Am J Psychiatry 158: pp. 1728-1730 CrossRef
- Einarson, A, Selby, P, Koren, G (2001b) Abrupt discontinuation of psychotropic drugs due to fears of teratogenic risk and the impact of counseling.. J Psychiatry Neurosci 26: pp. 44-48
- Einarson, A, Bonari, L, Voyer-Lavigne, S, Addis, A, Matsui, D, Johnson, Y, Koren, G (2003) A multicentre prospective controlled study to determine the safety of trazodone and nefazodone use during pregnancy.. Can J Psychiatry 48: pp. 106-110
- Kulin, N, Pastuszak, A, Sage, S, Schick-Boschetto, B, Spivey, G, Feldkamp, M (1998) Pregnancy outcome following maternal use of the new serotonin reuptake inhibitors: a prospective multicentre study.. JAMA 279: pp. 609-610 CrossRef
- Kurki, T, Hiilesmaa, V, Raitasalo, R, Mattila, H, Ylikorkala, O (2000) Depression and anxiety in early pregnancy and risk for preeclampsia.. Obstet Gynecol 95: pp. 487-490 CrossRef
- Marcus, SM, Flynn, HA, Blow, FC, Barry, KL (2003) Depressive symptoms among pregnant women screened in obstetric settings.. J Women’s Health 12: pp. 373-380 CrossRef
- Mathews, TJ, Menacker, F, MacDorman, MF (2003) Infant mortality statistics from the 2001 period linked birth/infant death data set.. Nat Vital Stat Rep 52: pp. 1-28
- McElhatton, PR, Garbis, H, Elefant, E, Vial, T, Bellemin, B, Mastroiacovo, P (1996) The outcome of pregnancy in 689 women exposed to therapeutic doses of antidepressants: A collaborative study of the European Network of Teratology Information Services (ENTIS).. Reprod Toxicol 10: pp. 285-294 CrossRef
- Nulman, I, Rovet, J, Stewart, DE, Wolpin, J, Gardener, HA, Theis, J (1997) Neurodevelopment of children exposed in utero to antidepressant drugs.. N Engl J Med 336: pp. 258-262 CrossRef
- Orr, ST, Miller, CA (1995) Maternal depressive symptoms and the risk of poor pregnancy outcome. Review of the literature and preliminary findings.. Epidemiol Rev 17: pp. 165-171
- Pastuszak, A, Schick-Boschetto, B, Zuber, C, Feldkamp, M, Pinelli, M, Donnenfeld, A, McCormak, M, Leen-Mitchell, M, Woodland, C, Gardner, A, Hom, M, Koren, G (1993) Pregnancy outcome following first trimester exposure to fluoxetine.. JAMA 269: pp. 2246-2248 CrossRef
- Zuckerman, B, Amaro, H, Bauchner, H, Cabral, H (1989) Depressive symptoms during pregnancy: relationship to poor health behaviors.. Am J Obstet Gynecol 160: pp. 1107-1111
- Use of antidepressants by pregnant women: Evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making
Archives of Women's Mental Health
Volume 8, Issue 4 , pp 214-220
- Cover Date
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- Keywords: Pregnancy; antidepressants.
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- Author Affiliations
- A1. The Motherisk Program, The Hospital for Sick Children, Toronto, Canada
- A2. Faculty of Pharmacy, The University of Toronto, Toronto, Canada
- A3. Department of Psychology, University of Toledo, Toledo, OH, U.S.A.
- A4. Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada